Abstract 17959: Is External Chest Compression Safe in Ventricular Assist Device Patients? A Case Series

Abstract

Introduction: Current resuscitation guidelines do not address ventricular assist device (VAD) population. However, commonly adopted resuscitation algorithms discourage use of external chest compression (ECC). This deviation from convention is largely driven by the concern that ECC could dislodge the VAD inflow cannula. We present a case series of 4 patients with left ventricular assist device (LVAD) that underwent ECC during CPR without suffering any ill effects. One patient underwent targeted temperature therapy (TTT) after arrest and had successful neurological recovery. Hypothesis: 1. ECC may be safe and effective in patients with VAD. 2. End tidal CO2 (ETCO2), a surrogate for cardiac output, can guide initiation of ECC in this population. Methods: This case series was performed at a single North American tertiary medical center. Clinical data was gathered by review of hospital chart. Autopsy data was used to verify integrity of VAD after ECC. Baseline characteristics are described in Table 1. Results: Three out of these four patients underwent ECC. One had a VAD implant within 60 days of this event. Autopsy showed that VAD circuit was intact in all three including the fresh implant. The fourth patient with respiratory failure didn’t receive ECC because ETCO2 value was higher than 20 mm Hg. ROSC was established in two patients with ETCO2 greater than 10 mm Hg, none survived to hospital discharge. TTT was performed in one patient with improvement in neurological status.Results are described in table 2. Conclusions: ECC can be safely performed in VAD patients. ETCO2 less than 20 mm Hg can be used to initiate ECC. ETCO2 could predict survival in this population. TTT can be safely performed in VAD. More evidence is needed to consolidate these findings.